Tuesday, 30 January 2018

Post- Partum Perineal Tears and Episiotomy Infections

For anyone who has read my Birth Stories for both kids, knows I go into quite a lot of detail on what actually happens when giving birth, if you find those to much to handle and are squeamish then I would look away now and not carry on with this blog post below.


After Bubs2 made her very fast entrance into this world via an assisted forceps delivery, everyone told me it was great I did not have the planned C-section I was booked in for, as now my recovery time would be quicker and I could get back to normal life especially with a toddler in tow. Having always believed giving birth was the difficult part, I was about to be proved very wrong in the days that followed Bubs2 birth.

With my first birth being quite eventful, my recovery although the majority was done in hospital it was fairly straight forward. Despite having both an episiotomy and c-section I was back to feeling normal and up and about within a few days. With the second though it was a different story, one which I feel needs to be shared. Once I started explaining to people what had happened I heard so many similar stories, but no one had ever talked about this before when I was pregnant either time.


We were discharged from hospital the day after Bubs2 was born in the afternoon, which was great for me as I could not wait to get back to my mums and see Bubs, very glad to not have the week long stay like I did first day around. On Monday things were sore like I expected they would be after pushing out a baby from that region with the help of forceps and an epistomoy but I continued taking regular pain killers and it was uncomfortable but bearable.


By Tuesday I thought the pain would have improved but it still felt the same and when the community midwife visited I mentioned I felt as if I may have any infection, she checked and said she could not see any signs of one, but if anything changed to visit my GP as there maybe an internal infection.

Lying awake in bed on Tuesday night whilst feeding I just felt something was not quite right, through work we have access to Babylon which gives you a GP appointment via a phone consulation straight   from your phone, so I booked one for first thing Wednesday morning at 9am.


Although modern technology is great, this GP told me to book into see my actual GP asap as I had just given birth so should be seen straight away. Thankfully I was able to get an emergency appointment with a great GP who confirmed I did definitely have an infection and that some of my stitches had already started to fall out. She immediately phoned triage at Queen Charlotte's and Chelsea Hospital and arranged for me to be seen in addition to prescribing me antibiotics to start taking.
It was time for Bubs2 first ever outing at 3 days old, we went back to the hospital she was born at. It was very strange walking around holding a tiny baby in my arms rather than in my stomach like at all those appointments during my pregnancy.

The doctors and midwives in triage could only give me strong painkillers, they were unable to do anything else until the infection cleared. They arranged for me to come back the following week to see a perennial tear specialist to decide the next course of action. My initial worry was how I would last for a week in this much agony and how I would continue to feed. Thanks to amazon prime one of the first things I did was order a special post recovery cushion to enable me to sit. This cushion ended up being my best friend over the following weeks, wherever I went she went too, it was a long time before I could sit down and stand up without wincing.

Wednesday also coincided with Day 3 after giving birth, the day otherwise know as when your milk comes in and you cry. It didn't take much for me to cry that evening. I would say on a scale of 1-10, giving birth for me is around a 7, this pain I was in from the infection was around a 12 and unlike contractions it was constant.

I ended up calling triage back again in the middle of the night unable to handle it any longer, but they explained the only thing they could do would be give me strong painkillers in the morning once the hospital pharmacy opened up. I drugged myself up that night and some how managed to keep feeding Bubs2 through the night by lying down.


Luckily we were still staying with my parents after I came home from hospital, so we had lots of extra help with both kids. Without this I do not think I would have survived, I even got breakfast in bed on Thursday morning and I spent the entire day in bed asleep. Only leaving to feed myself or Bubs2. The extra help was great to help me rest and recovery especially with a toddler to look after too. I recently read a blog post on closing the drawbridge after giving birth and spending the first week in bed followed by the second week on the sofa, this is what I ended up doing but without support and help I do not think its so easy to do.


By Friday the pain had reduced a little, around a 8-9 now on the scale and I had my five day midwife check, she explained everything in more detail to me.
The infection may have been caused during the episiotomy incision, especially since this was my second time meaning there was already scar tissue in that area, or due to the forces or restitching equipment. By Friday all of my stitches had come out, meaning the entire wound was now open. She explained they often do not restitch and instead allow the skin to naturally build up over time to heal, which can take up to 4 months. An active toddler and 4 months of discomfort just was not going to work for me. She also gave me some great practical advice which I have listed at the end of my story. The highlight of the whole week however was when Bubs2 had her first weighing in and had amazingly put on weight rather than losing it from her birth weight. It was a great feeling of achievement to know that despite all the pain, she was thriving and chubbing out each day, made everything seem worthwhile.

Thursday + week 

The following Thursday I had my follow up appointment at the hospital with a specialist. At the clinic there was nearly 10 other women all with similar symptoms and problems, most of whom had had an instrumental birth too, this showed me again how common this is after given birth. I heard so many stories from friends and family regarding complications with stitches, and although it is pretty hard to prevent an infection I wish I had known about this to be mentally prepared that the journey doesn't always end just after labour.

Back to the hospital, after examining me the consultant believed the best course of action to speed up recovery would be to restitch me. Just the idea of this scared the sizzle out of me, but she assured me it would not be as painful as the first time around and the most painful part would be administering the local anaesthetic I agreed to go ahead ( well I didn't have much choice) with the promise of being allowed gas&air throughout.

The doctor was right again after all and it was no where near as painful as the first time around. I had a great conversation with the doctor and midwife whilst completely high on gas & air. Immediately after being restitched I was given dicofenlac painkiller and reunited with Bubs who had been patiently sleeping in the waiting area with my mum. Whilst feeding her my palms became really itchy which I thought was strange but the doctor did not seem worried. As I was getting ready to leave the hospital and Mr S went out to get the car my whole body started itching and my throat became very tight, I went back to triage and they confirmed I was having an allergic reaction. Before I knew it I was back in the bay I had just been in hooked up to a steroid drip and antihistamines.

We ended up spending nearly the whole day in hospital and had to get my Dad to rush and pick up Bubs from nursery. It was a great feeling finally getting home that day to eat a giant jacket potato.

I do not want to scare anyone with the above and obviously every birth is different. I have a fairly high pain threshold and the pain I was in post recovery was probably the worst I have felt in my life, way worse than labour, vaginal delivery or a c-section. Whatever type of birth you have their is always a chance of infection. In addition to my top tips below I would advise you to try and catch it early and get those antibiotics into you as soon as you can.

The most important thing when pregnant is for the baby and you to be healthy and safe, so remember to pay attention to your body too. As much as you can try and plan and prepare, with giving birth you never know what will happen. Rest and recovery is so important in those early days.

My restitches were a lot stronger than the standard ones first given and took around 4 -5 weeks to dissolve completely, so my recovery time ended up being the same as having a C-section in the end. I am now completely back to normal, have forgotten the pain and can't wait for baby number 3 - just kidding, I just wanted to check who was still reading this far.

Top Tips for Recovering from Post-Partum Perineal Tears and Infections

1.Foam Ring Doughnut Cushion - buy one of these - you will love - it will love you

2.Frozen Sanitary Towels - sprinkle some water and aloe vera gel and place into the freezer

3. Jug or Water Bottle in the Toilet - use when passing urine and to ensure everything is clean

4.Kitchen Roll - use this to dry yourself instead of toilet roll - much more absorbent - keeps things dry

5.Hairdryer - for a extra layer of dryness - prevents infection spreading

6.No products - just water when bathing

7.Shower not bath - shower instead of lying in a bath again to prevent infection

8.Arnicha tablets - speeds up recovery

9.Diet - lots of water, fruit, veg and fibre - to keep up your strength and improve recovery time

10.Movement - as much as you can - improves blood flow and speeds up recovery

Thursday, 25 January 2018

Kenya with a Toddler - Top Ten Travel Tips

In collaboration with #babycantravel my Top Ten Travel Tips if travelling to Kenya with a Toddler.

Bubs was around 18 months when we first visited Kenya and the below summarises what I found most useful :)

1. Vaccinations and Malaria

Ensure your little one and yourself is fully vaccinated before going by checking with your local Travel Clinic, some vaccinations will be dependant on the areas you are travelling within Kenya itself. For example if just visiting Nairobi not all are required but if you are planning on doing Masai Mara and the coastline its best to be prepared. Some vaccinations are also only available privately such as yellow fever and you may need to carry the certificate for this whilst there.
Malaria tablets will also need to be taken depending on which parts of Kenya you are travelling too, Bubs had to take one tablet a day whilst we were there and I found the best way to give this to him was to first crush it between two spoons and then hid it in a desert such as custard, jam, ice cream, banana basically anything sweet that would disguise how bitter the taste is, also found it easier to give it in food as I knew it would be eaten in one mouthful rather than mixed with milk in case he did not finish his drink.

2. Car Seat and Baby Equipment

Hire a car seat locally - I used a company called Baby Mama who were great, they also have other items for hire and are very responsive to emails and being in touch with you once you land in Nairobi.  They will arrange a drop off and pick that is convienant for yourself,  this made it much easier than transporting one from the UK. Aside from the obvious health and safety aspect of using one, a car seat is a big necessity firstly due to the amount of traffic in Nairobi. If you read through my blog post - Kenya Part 1 it details how long it took for us to drive from the airport to hotel when we landed. Even going for lunch in Nairobi you will need to allow around an hour for your journey. Secondly for travelling long distance, although no legal requirements to have car seats, it is much easier for both you and your little one and you. Some drives we did took around 5-6 hours in total and this meant he could have a long nap and play in his seat safely for most of the time.
The only other piece of baby equipment I used was the travel steriliser, I used a Milton cold water system for bottles on a few occasions.I also took a portable highchair with me, but never needed to use it in the end as all restaurants we visited provided these.

3. Clothing

Whichever time of year you go I would still take lots of light layers for your little one as it can get chilly during early mornings and the evenings, especially when you are out in the Masai Mara.
We went during the rainy season so good waterproofs were essential, even along the coast where during the day we had beautiful blue skies and 30 degrees it still got cooler in the evenings. Also good to have thin long sleeves and trousers to provide additional protection against mosquitos.

4. Insect Repellant and Bite Relief

We were very lucky and did not get bitten at all, but it is always best to be prepared with baby safe insect repellant and relief - we use Mosquito Spray and After Bite Relief. I always carry both of these whichever country we visit in my first aid kit. You can also take precautions such as using the mosquito nets surrounding the beds when sleeping.

5. Milk

I travelled with lots of pre-made formula, as we were flying with emirates we had a huge weight allowance of around 48kg each multiplied by 16 travellers that was loads. Pre - made formula is by far your best bet when travelling around as road trips are often longer than expected and we were unsure where we would be and at what time of day. Having cartoons on me meant I was always prepared, it also helps if using toddler milk cartoons as they come with an attached straw  providing an instant hygienic solution anywhere without the need for bottles, beakers and sterilisers.

I also took Longline UHT milk with me in my suitcase which was great to keep in the fridge for cereal ( also took cereal) and I requested the hotels to use this to make him some fresh fruit refreshing milkshakes, these helped cool him down after a morning in the pools.

With regards to local milk, he did drink this a few times too when we were staying at hotels and in the Mara and was fine with it, no reactions or upset tummies, again it has all been pasteurised but it is nice for the little ones to also have a familiar taste of home when everything else is so different for them mainly at bedtimes.

6. Nappies

Tuskers is a large supermarket in Kenya which sells lots of baby items including Pampers, these were more expensive than buying from here but as we were not tight on luggage allowance I took my own from England. Also if you are planning on buying them out there stock up when in major towns or cities, as nappies will not be available in a lot of the more remote locations.

7. Food and Snacks

I took a lot of snacks with us for journeys, entertainment and keeping Bubs happy which worked great and a few ready made packets of food. He loved all his snacks but did not eat any packet food, only had local food and was fine. The cuisine included a lot of his favourites such as grilled meats, cassava and corn on the cob.

8. Wipes and Hand- Sanitiser

Take lots of these as public toilets in particular only give you tissue after a tip, not good if you are unprepared with no change. As with travelling to any country, or even down the road - kids will always end up getting them sticky so the best course of action is to be prepared. We also did some glamping with Bubs so wipes are great when the water supply is only temporary.

9. Nappy Changing

There are hardly any facilities to do this anywhere, which is fine as babies and toddlers are very adaptable but you just have to be willing to change them wherever you can. Bubs used the back of car, van, benches and most often the floor such as in Nairobi domestic airport.

10. Animals

A huge part of visiting Kenya is the safari, one thing to be aware of when taking very young children is no car seats and also the morning safaris mean an early start for them.

Links to our Kenya Blog Posts:

Part 1 - The Journey - London - Nairobi
Part 2 - Narok
Part 3 - Masai Mara and Nairobi`
Part 4 - Diani Beach

Wanderlust Kids